Anaesthesia
-
Goal-directed coagulation therapy is essential in the management of trauma patients with severe bleeding. Due to the complex nature of coagulation disorders in trauma, a quick and reliable diagnostic tool is essential. We report a severely injured multiple trauma patient who received haemostatic therapy with coagulation factor concentrates, guided by rotational thromboelastometry (ROTEM). ⋯ This approach enabled extended emergency hemihepatectomy to be performed without using fresh frozen plasma. As the EXTEM maximum clot firmness showed good clot quality, no platelets were transfused despite low platelet counts. This case shows the potential success of treatment using both fibrinogen concentrate and prothrombin complex concentrate, not only in restoring haemostasis but also in minimising requirement for transfusion of allogeneic blood products.
-
We investigated whether insertion of an LMA Supreme and its use for maintenance of anaesthesia is feasible in the prone position. Forty adult patients positioned themselves prone and were given propofol until the Bispectral Index was < 50. A size-4 LMA Supreme was inserted by experienced anaesthetists. ⋯ The frequency of blood staining and sore throat was 7.5% each. No other complications were noted. We conclude that use of the LMA Supreme in the prone position by experienced users is feasible.
-
Case Reports
Lipid resuscitation in a carnitine deficient child following intravascular migration of an epidural catheter.
A child with cerebral palsy and carnitine deficiency developed ventricular arrhythmias with loss of cardiac output during elective surgery under general anaesthesia with concomitant epidural analgesia. Sinus rhythm was restored on administration of adrenaline, but hypotension persisted despite resuscitation. ⋯ Blood samples taken before and after the lipid bolus did not demonstrate toxic concentrations of bupivacaine. This case suggests that carnitine deficiency may increase susceptibility to bupivacaine cardiotoxicity.